When to establish the first av fistula?
It is a poor strategy to start dialysis treatment when residual renal function is lower than the accepted optimum for patients on dialysis treatment. At a serum creatinine level of more than 6 8 mg/dl in non-diabetic patients and of more than 4 6 mg/dl in diabetic patients dialysis therapy should be started. That means that a vascular access should be created before then. A well-functioning vascular access at the start of haemodialysis treatment saves costs of hospitalization and avoids large-bore central venous catheters for temporary access with all their potential complications. What is the procedure of choice? • In patients with poor vessels the first operation should be planned 3 or 4 months prior the expected start of haemodialysis. One should make allowance for a prolonged period of maturation. In some patients, a second or third operation will be necessary to establish a satisfactory vascular access. • In patients with good, suitable arteries and veins, referral to the vascular
